CSA Subscription Form (Printable Adobe Acrobat - pdf format)
Orchard Country Produce CSA Subscription Form
Name:____________________________________________________ # in family___________
Address:______________________________________________________________________
Phone:________________________________________________
E-mail: (One that is checked regularly so that you can be updated: ________________________________________________________
Pick up site or delivery:_________________________________________________________________
Columbia Public Library - Thurs., Bethesda [Woodmont/Norfolk] - Sat. and Tues., Westminster Mkt. - Sat., Wash DC DOT Bld. [3rd & M St.] S.E. Gaithersburg Mkt -Thurs.
other areas - give address - We will deliver to Carlisle, and other areas if it can be arranged.
Circle the plan or plans that you want to subscribe to: Plan 1 2 3 4 5 6
Plan 1 7 Week Large Share June 1- July 18 $250.00 Plan 2 7 Week Large Share July 20 - Sept 5 $250.00 Plan 3 7 Week Large Share Sept 7 - Oct 24 $250.00 Plan 4 7 Week Small Share June 1 – July 18 $150.00 Plan 5 7 Week Small Share July 20 – Sept 5 $150.00 Plan 6 7 Week Small Share Sept 7 - Oct 24 $150.00
Payment due dates: Payment in full due on or before April 30, 2009
Monthly installments due Jan 31, Feb 28, Mar 31, April 30
Single plan payments: Large – $62.50/month x 4 = $250.00
Small - $37.50/month x 4 = $150.00
Any Two plan payments: Large - $125.00/month x 4 = $500.00
Small - $75.00/month x 4 = $300.00
Full season plan: Large - $181.25/month x 4 = 725.00
Small - $106.25/month x 4 = $425.00
Please send check or money order to: Orchard Country Produce
Gregg and Louise Keckler
1410 Goodyear Rd.
Gardners, PA 17324
This year we will again be offering: bread, jellies, honey, horseradish, ground beef and steaks, pork, eggs, butter, cheese and milk.
You may list one item from our calendar that you would rather not receive in your shares. We will do our best to give you a custom share. Sometimes we do forget, though. If you are willing to try anything just leave this blank.
1)__________________________________________